(43) Comparison of Temporary Covered Epithelialized Palatal Graft vs. Conventional Epithelialized Palatal Graft for Keratinized Tissue Gain Around Dental Implants. A pilot study

Introduction: Epithelialized Palatal Grafts (EPG) represent the gold standard technique to increase the width of keratinized gingiva (KG) and vestibular depth both around teeth and dental implants. One of the key steps for a successful EPG procedure is graft stability during the first days of healing, when the graft is being revascularized. Various EPG techniques have been described in the literature including the use of stents and different suturing approaches. One of these approaches involves EPGs temporarily covered with the buccal flap to stabilize the graft in the initial stages of healing. Although, this method is currently used by many clinicians, a direct comparison with a conventional uncovered EPG hasn’t been investigated yet. Thus, the aim of this pilot study is to monitor the keratinized tissue width (KTW) and vestibular depth (VD) changes following a temporary covered epithelialized palatal graft (EPG) compared to a conventional EPG, around dental implants, over a six- month follow-up period.

Methods: 12 systemically healthy and nonsmoker patients presenting with lack of KG ( < 2mm) around an anterior dental implant (first premolar to first premolar) were recruited in this study. Six of the patients were treated with a conventional uncovered EPG and the remaining 6 with a temporarily covered EPG. In the latter group the sutures holding the buccal flap were removed at 3 days post-surgery, allowing the flap to reposition apically and expose the graft. KTW and graft dimensional changes were evaluated with the use of digital impression technology, while the VD was recorded using an esthetic lip ruler. Digital impressions of the surgical site and VD measurements were taken at pre-op, immediately after surgery, at 1-month and 6-month follow-up. Patient-reported pain outcomes were also assessed using a pain assessment questionnaire delivered to patients at the 3-day and 2-week follow-up.

Results: A statistically significant increase of KG and VD was found for both groups compared to baseline, while no statistically significant differences were seen for any of the two parameters between the groups. Similarly, patient reported comparable pain levels whether they received the conventional or the temporarily covered EPG.

Conclusions: Temporarily covered EPGs present with similar KG and VD increases as conventional EPGs and they represent a well-accepted procedure by the patients. With the rise of full arch implant supported dental prosthesis, practitioners should consider this simple novel technique as an alternative to a traditional EPG to extend vestibular depth and increase keratinized tissue.

Lead Author’s Contributions to the Research Project: The lead author was responsible for recruiting subjects, performing surgeries, data collection, and composition of the abstract.